Bilateral Retropharyngeal Parathyroid Hyperplasia Detected with 4D Multidetector Row CT

Abstract

We present a case of bilateral retropharyngeal parathyroid hyperplasia detected with 4D-CT in a patient with persistent primary hyperparathyroidism and failed neck exploration. We discuss the embryologic basis of ectopic retropharyngeal parathyroid adenomas and hyperplasia and the utility of 4D-CT in their localization for surgical planning.

Diagnostic Accuracy of 4D-CT for Parathyroid Adenomas and Hyperplasia

“…It is important to be cognizant of the radiation dose delivered with CT, particularly multiphase CT. We use dose reduction techniques with 4D-CT, as described by Welling et al, 8 including automatic tube current modulation and limiting the superior field of view to the mandibular teeth. Despite these techniques, 4D-CT delivers a significant radiation dose.…”

“…4D-CT is a novel method of multiphase CT imaging. [5][6][7][8] This technique utilizes the principles of altered arterial enhancement and washout that guided early angiographic detection of parathyroid adenomas. 9,10 Our hypothesis is that preoperative 4D-CT can accurately localize the abnormal parathyroid gland found at surgery.…”

4D-CT for Preoperative Localization of Abnormal Parathyroid Glands in Patients with Hyperparathyroidism: Accuracy and Ability to Stratify Patients by Unilateral versus Bilateral Disease in Surgery-Naïve and Re-Exploration Patients

“…12,13 Many different protocols have been advocated in the literature for 4D-CT. These are typically 2-phase scans with imaging acquired only after contrast 20,21 or imaging acquired both before and after contrast.…”

Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy

“…per chest [2,[5][6][7]. Thus, the advantages of 4D CT should be carefully weighed against potential hazards associated with higher radiation exposure.…”